Wayne Co RECEIVED
CITY Or Ping FMMFAD
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS ob
FP1R POLITICAL PRACTICES COMMISSION
DOCUMENT COVER PAGE cm CLERKS OFFICE
Please type or print In ink. BY:_____
NAME OF FILER ((AST} (FIRST) IMIDDLEI
Co Wayne
t Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Rosemead
Division,Board,Department, District if applicable Your Position
Public Safety Senior Code Enforcement
a If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency. Position
2. Jurisdiction of Office (check at least one box)
State ❑Judge or Court Commissioner(Statewide Jurisdiction)
❑Multi-County ❑County of
V1 City of Rosemead ❑other
3. Type of Statement (Check at least one box)
• Annual: The period covered is January 1, 2015.through ❑ Leaving Office: Date Left I J
December 31,2015. (Check one)
bf-
The period covered is I J through 0 The period covered is January 1, 2015, through the date of
December 31.2015. leaving office.
•or•
❑ Assuming Office: Date assumed 0 The period covered is ,through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Pan Y.
4. Schedule Summary(must complete) a Total number of pages including this covet page:
Schedules attached
❑ Schedule A-1-Investments—schedule attached ❑Schedule C-Income,Loans, 8 Business Positions—schedule attached
❑ Schedule A-2-Investments—schedule attached ['Schedule O-Income—Gifts—schedule attached
❑ Schedule B•Real Properly—schedule attached ❑Schedule E•Income—Gifts—Travel Payments—schedule attached
-or-
,0None• No reportable interests on any schedule
5. Verification
MAILING ADORERS STREET CITY STATE ZIP CODE
.8usmes or Agency Address Recommended-Pubic Daumenl)
8838 East Valley Boulevard Rosemead CA 91770
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
( 626 ) 569-2100
I have used all reasonable diligence in preparing this statement I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under/1 the laws of the State of California that the foregoing is true and cor t.
Date Signed 62-1 II W Signature 4
(month,day yew) k the aginallysgnS statement with your ing o c.)
FPPC Form 700(2015/2016)
FPPC Advice Email:advice@fppcca.gov
FPPC Toll-Free Helpline:866/275-3712 www.fppc.ca.gov